Provider First Line Business Practice Location Address:
453 S SHAMOKIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAMOKIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17872-6407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
272-241-9069
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2020